Lung Cancer

Question 1

Histology of non-small cell lung cancer (~80%)

Answer 1

Adenocarcinoma (around 40%)

Squamous cell carcinoma (around 20%)

Large-cell carcinoma (around 10%)

Other types (around 10%)

Question 2

Histology of small cell lung cancer (~20%)

Answer 2

Cells contain neurosecretory granules that can release neuroendocrine hormones

This makes SCLC responsible for multiple paraneoplastic syndromes

Question 3

Signs and symptoms of lung cancer

Answer 3

Shortness of breath

Cough

Haemoptysis

Finger clubbing

Recurrent pneumonia

Weight loss

Lymphadenopathy – often supraclavicular nodes are the first to be found on examination

Question 4

CXR findings in lung cancer

Answer 4

Hilar enlargement

“Peripheral opacity” – a visible lesion in the lung field

Pleural effusion – usually unilateral in cancer

Collapse

Question 5

Investigations in lung cancer

Answer 5

CXR

Staging CT (contrast enhanced)

PET-CT (using radioactive tracer)

Bronchoscopy

Histological diagnosis

Question 6

Management of non-small cell lung cancer

Answer 6

Non-small cell lung cancer:
Surgery first line
Radiotherapy can be curative
Chemotherapy as adjuvant therapy

Question 7

Management of small cell lung cancer

Answer 7

Chemotherapy + radiotherapy

Question 8

Palliative treatment in lung cancer

Answer 8

Endobronchial treatment with stents/debulking

Chemotherapy

Question 9

Extrapulmonary manifestations in lung cancer

Answer 9

Recurrent laryngeal nerve palsy (hoarse voice)

Phrenic nerve palsy (SOB)

SVC obstruction

Horner’s syndrome

SIADH

Cushing’s syndrome

Hypercalcaemia

Limbic encephalitis

Lambert-Easton myasthenic syndrome

Question 10

Lamber-Easton myasthenic syndrome

Answer 10

Antibodies produced against small cell lung cancer cells

These antibodies also target and damage voltage-gated calcium channels sited on the presynaptic terminals in motor neurones leading to weakness

Question 11

Symptoms of Lambert-Easton syndrome

Answer 11

Weakness in proximal muscles

Weakness in intraocular muscles (diplopia)

Weakness in levator muscles (ptosis)

Weakness in pharyngeal muscles (slurred speech, dysphagia)

Dry mouth, impotence and dizziness due to autonomic dysfunction

Question 12

What to consider in older patients with symptoms of Lambert-Easton syndrome

Answer 12

Small cell lung cancer

Question 13

What is mesothelioma?

Answer 13

Lung malignancy affecting the mesothelial cells of the pleura

Strongly linked to asbestos inhalation

Huge latent period between exposure to asbestos and development of mesothelioma (up to 45 years)